Niacin and Heart Disease: Prescriptions Rise, But Evidence Lacks

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Prescriptions for niacin have jumped in recent years, raising
questions about whether the more than $900 million the United
States now spends yearly on the vitamin is wise, given that it
has failed to show benefits for preventing deaths from
cardiovascular disease in the last two large clinical trials.

Use of niacin, also known as vitamin B3, nearly tripled over an
eight-year period to reach almost 700,000 U.S. prescriptions
monthly by the end of 2009, researchers found. Of all niacin
prescriptions written that year, 80 percent were for Niaspan,
slow-releasing tablets of niacin made by Abbott Laboratories.

"Our study shows that prescription niacin sales are substantial
and growing, even in the absence of contemporary supportive trial
evidence," that the vitamin lowers people's risk of dying from
heart disease, the researchers wrote in their article,
published today (June 10) in the Journal of American Medical
Association.

Niacin is one of the body’s essential nutrients, meaning the body
is unable to produce the amount it needs on its own, and so it
must be consumed in the diet. In high doses, evidence shows that
it increases
good cholesterol while lowering bad cholesterol. Researchers
suspected that these two effects might mean it lowers the risk of
cardiovascular diseases, including heart attacks, angina and
strokes.

The first-choice drug treatment to prevent heart problems by
reducing high cholesterol is use of cholesterol-lowering drugs
called statins. Researchers had hoped that niacin would help
in prevention too, by raising the good type of cholesterol.

Drugs like Niaspan are designed to avoid the unpleasant side
effects of high doses of niacin by gradually releasing the
vitamin, but they can harm the liver. Sales of Niaspan reached
$911 million last year.

In 2011 and 2012, two large studies involving nearly 30,000
patients in total found no benefits of taking Niaspan, or another
niacin drug in addition to
statins, in terms of reducing deaths and nonfatal heart
attacks and strokes.

In the new study, researchers led by Cynthia A. Jackevicius, an
associate professor of pharmacy at Western University of Health
Sciences in Pomona, Calif., looked at prescription data for the
United States and Canada between 2002 and 2009, and found that
even though niacin use has increased in Canada too, it was
six-times more frequently prescribed in the United States.

"The discordance between sales and evidence should be a focus of
professional dialogue about the role of this medication," the
researchers wrote.

Direct-to-consumer
advertising, specifically Niaspan's "intervention-style" ads
in the United States, may be to blame for people taking a drug
that isn't shown to work, the researchers wrote.